Outcomes of Acute Myocardial Infarction in Patients with Influenza and Other Viral Respiratory Infections

Vejpongsa, Pimprapa; Kitkungvan, Danai; Madjid, Mohammad; Charitakis, Konstantinos; Anderson, H. Vernon; Arain, Salman A.; Balan, Prakash; Smalling, Richard W.; Dhoble, Abhijeet

doi:10.1016/j.amjmed.2019.05.002

Cited by 43 publications

(24 citation statements)

References 31 publications

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“…Since increased mortality was driven by MI patients, and none of the tested MI patients that survived or died were SARS-CoV-2 positive, it is rather unlikely that a significant amount of patients may have been SARS-CoV-2 positive. Nevertheless, it remains to be discussed that viral respiratory infections have been proven to increase the risk of ACS as shown for influenza, implying also a potential direct effect of SARS-CoV-2 infections on ACS incidence and outcome during the COVID-19 pandemic [28]. While the incidence of ACS in patients with COVID-19 remains poorly understood, it has been proposed that plaque rupture, coronary spasm or microthrombi owing to systemic inflammation or cytokine storm may trigger ACS in COVID-19 patients [29].…”

Section: Plos Onementioning

confidence: 99%

Complications and mortality of cardiovascular emergency admissions during COVID-19 associated restrictive measures

et al. 2020

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While hospital admissions for myocardial infarction (MI) and pulmonary embolism (PE) are decreased during the COVID-19 pandemic, controversy remains about respective complication and mortality rates. This study evaluated admission rates, complications, and intrahospital mortality for selected life-threatening cardiovascular emergencies (MI, PE, and acute aortic dissection (AAD)) during COVID-19-associated restrictive social measures (RM) in Styria, Austria. By screening a patient information system for International Statistical Classification of Diseases and Related Health Problems (ICD) diagnosis codes covering more than 85% of acute hospital admissions in the state of Styria (~1.24 million inhabitants), we retrospectively identified patients with admission diagnoses for MI (I21, I22), PE (I26), and AAD (I71). Rates of complications such as cardiogenic shock and cardiopulmonary resuscitation, treatment escalations (thrombolysis for PE), and mortality were analyzed by patient chart review during 6 weeks following onset of COVID-19 associated RM, and during respective time frames in the years 2016 to 2019. 1,668 patients were included. Cumulative admissions for MI, PE and AAD decreased (RR 0.77; p<0.001) during RM compared to previous years. In contrast, intrahospital mortality increased by 65% (RR 1.65; p = 0.041), mainly driven by mortality following MI (RR 1.80; p = 0.042). PE patients received more frequently thrombolysis treatment (RR 3.63; p = 0.006), while rates of cardiogenic shock and cardiopulmonary resuscitation remained unchanged. Of 226 patients hospitalized during RM, 81 patients with suspected COVID-19 disease were screened for SARS-CoV-2 infection with only 5 testing positive. Thus, cumulative hospital admissions for cardiovascular emergencies decreased during COVID-19 associated RM while intrahospital mortality increased.

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Section: Plos Onementioning

confidence: 99%

Complications and mortality of cardiovascular emergency admissions during COVID-19 associated restrictive measures

et al. 2020

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“…Vejpongsa et al analysed over 1.8 million admissions for acute myocardial infarction in 2013-2014, and found that influenza and other respiratory viral infections were diagnosed in about 1.1% of patients. Acute myocardial infarction patients with concomitant influenza infection were hospitalized for a longer time, had a higher risk of development of shock, acute respiratory failure and acute kidney injury, and a higher rate of blood transfusion, but most importantly had a worse outcome than those with acute myocardial infarction alone, in terms of the in-hospital case fatality rate [15]. Another study, by christiansen et al, demonstrated that influenza vaccination was associated with a significant 8% decrease in one-year mortality in patients previously hospitalized at intensive care units (hr 0.92; 95% ci: 0.89-0.95), a decreased risk of stroke (hr 0.84; 95% ci: 0.78-0.92), but only a small, non-significant decrease in the risk of myocardial infarction [16].…”

Section: Risk Groups For Severe Influenza and Development Of Influenzmentioning

confidence: 99%

Recommendations for the prevention, diagnosis and treatment of inFLUenza in adults for Primary care physiciAnS: FLU COMPAS PCP – ADULTS

Mastalerz-Migas¹,

Kuchar²,

Nitsch–Osuch³

et al. 2020

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influenza is an acute infectious disease of viral etiology which, unlike the common cold, can lead to serious complications such as pneumonia, myocarditis, inflammation of the kidneys, nervous system, and muscles, and even death. Vaccination is the most effective method of preventing influenza and should be recommended to everyone over six months of age, with particular emphasis on risk groups. When the symptoms of influenza occur, the only drugs recommended for curative treatment are neuraminidase inhibitors (of which only oseltamivir is available in Poland). influenza diagnosis of should be made during the epidemic season based on clinical signs. Only curative treatment should be employed in risk groups. treatment should not be delayed in order to wait for the results of tests confirming infection.

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“…COVID-19 and other acute respiratory viruses have both been reported to be associated with higher risk of arterial thrombotic events as well. Acute coronary syndrome is reported in no greater than 3% of acute in uenza or other viral infections 5,30 whilst in COVID-19, the rates vary from 3.4% to 11.2% 21,31 . We, however, reported low arterial event rates in our patient cohorts and the potential reasons accounting for these differences are likely to be similar to those discussed above for VTE.…”

Section: Discussionmentioning

confidence: 99%

A Comparison of Clinical and Laboratory Manifestations of Thrombotic Events in Patients with COVID-19 and Other Respiratory Viral Infections

et al. 2020

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COVID-19 caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) and other respiratory viral (non-CoV-2-RV) infections are associated with thrombotic complications. The differences in prothrombotic potential between SARS-CoV-2 and non-CoV-2-RV have not been well characterised. We compared the thrombotic rates between these two groups of patients directly and further delved into their coagulation pro les. In this single-center, retrospective cohort study, all consecutive COVID-19 and non-CoV-2-RV patients admitted between January 15 th and April 10 th 2020 were included. Coagulation parameters studied were prothrombin time and activated partial thromboplastin time and its associated clot waveform analysis (CWA) parameter, min1, min2 and max2. In the COVID-19 (n=181) group there were two (1.0 event/1000-hospital-days) thrombotic events while one (1.8 event/1000-hospital-day) was reported in the non-CoV-2-RV (n=165) group. All of these events were myocardial infarction occurring in the intensive care unit. Coagulation parameters did not differ throughout the course of mild COVID-19. However, CWA parameters were signi cantly higher in severe COVID-19 compared with mild disease, suggesting hypercoagulability (min1: 6.48%/s vs 5.05%/s, P<0.001; min2: 0.92%/s 2 vs 0.74%/s 2 , P=0.033). In conclusion, the thrombotic rates were low and did not differ between COVID-19 and non-CoV-2-RV patients. The hypercoagulability in COVID-19 is a highly dynamic process with the highest risk occurring when patients were most severely ill. Such changes in haemostasis could be detected by CWA. In our population, a more individualized thromboprophylaxis approach, considering clinical and laboratory factors, is preferred over universal pharmacological thromboprophylaxis for all hospitalized COVID-19 patients and such personalized approach warrants further research.

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Outcomes of Acute Myocardial Infarction in Patients with Influenza and Other Viral Respiratory Infections

Cited by 43 publications

References 31 publications

Complications and mortality of cardiovascular emergency admissions during COVID-19 associated restrictive measures

Complications and mortality of cardiovascular emergency admissions during COVID-19 associated restrictive measures

Recommendations for the prevention, diagnosis and treatment of inFLUenza in adults for Primary care physiciAnS: FLU COMPAS PCP – ADULTS

A Comparison of Clinical and Laboratory Manifestations of Thrombotic Events in Patients with COVID-19 and Other Respiratory Viral Infections

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